Measuring What Matters in Older-Person Care: What a Practical Quality Measurement Framework Could Look Like for Viet Nam
IMPLEMENTATION, MEASUREMENT & IMPROVEMENT
Measuring What Matters in Older-Person Care: What a Practical Quality Measurement Framework Could Look Like for Viet Nam
IMPLEMENTATION, MEASUREMENT & IMPROVEMENT
Last reviewed: October 2026
Health systems rarely lack data. Hospitals count admissions, deaths, infections, readmissions, procedures and waiting times. Primary-care services count visits, diagnoses and screenings. Community programs can report how many older people attended an activity or received an assessment. Long-term-care providers may track falls, medication incidents or hospital transfers.
The harder question is whether those data tell us what we really need to know: are older people actually receiving better care?
For older people, quality often extends beyond treating a single disease or completing a single encounter. Good care may involve preventing avoidable harm, protecting or improving function, understanding what matters to the person, coordinating care across settings, supporting caregivers and responding as needs change over time.
This question is becoming increasingly important in Viet Nam. In 2024, the country had 14.2 million people aged 60 and older, 2.8 million more than in 2019, and this number is projected to approach 18 million by 2030. At the same time, policy is expanding periodic health assessment, geriatric services, home and community care and other models of support for older people. As capacity grows, measurement will increasingly need to move beyond asking how much care was delivered toward asking how well that care worked.
More indicators do not necessarily mean better measurement
The international literature already contains a very large number of indicators for older-person care. A systematic review of reviews and guidelines identified 6,391 quality indicators across acute, community and continuing-care settings. Process measures accounted for the largest share, and the indicators covered 39 different areas of care. Importantly, relatively few provided a comprehensive assessment across structure, process and outcomes.
More focused reviews tell a similar story. A review of care transitions identified 361 indicators from 89 programs across 12 countries. Home care had 226 indicators from nine programs in eight countries, while a review of long-term-care facilities found 327 indicators from 18 programs across 13 countries.
The problem, then, is not a shortage of things that could be measured. The challenge is deciding which measures are important enough to influence care and useful enough to justify the effort required to collect them.
A dashboard with dozens of indicators may look sophisticated but still leave frontline teams unsure which problems deserve action. A smaller set of clearly defined measures, linked to specific improvement goals, may be far more useful. Better measurement does not mean measuring more. It means measuring the right things, for a clear purpose, and using the results.
Start by being clear about what quality means
WHO describes quality health services as effective, safe, people-centered, timely, equitable, integrated and efficient. These dimensions provide an important starting point, but older-person care raises additional questions about what they mean when people live with multimorbidity, changing function, different priorities and care that crosses several settings.
Safety may include preventing medication harm or infection, but also avoiding unnecessary functional decline and reducing risk during transitions. Effectiveness may include disease control while also considering whether treatment supports the person’s ability to function and live as independently as possible. Integration becomes especially important when several professionals, family caregivers and organizations are involved.
WHO is also developing Global Standards for Quality Health Care Services for Older People. The project aims to produce standards, indicators and implementation guidance for person-centered, integrated and responsive care while promoting functional ability, autonomy, dignity and quality of life. A multidisciplinary Technical Working Group with members from 24 countries was announced in August 2026. The work is still under development and should not be treated as a finalized WHO standard or indicator set.
That international work reinforces a basic point: quality in older-person care cannot be reduced to a single clinical outcome or organizational score.
Structure, process and outcomes answer different questions
WHO’s 2025 manual for quality-indicator development uses the familiar Donabedian framework of structure, process and outcome and emphasizes fit-for-purpose indicators that can be integrated into routine information systems.
Structure asks whether the conditions for good care exist. Does an organization have appropriately prepared staff? Is there a defined care pathway? Can teams access rehabilitation, pharmacy or specialist support? Is there a mechanism for transferring information between settings?
Process asks whether intended care actually happened. Was medication reconciliation completed? Was a change in function recognized? Did an older person with reduced mobility receive an appropriate response? Was a referral completed? Was a caregiver involved where their role was necessary?
Outcome asks what happened to the person. Did function improve, remain stable or decline? Was avoidable harm prevented? Did a hospital-to-home transition work? Did the person experience care as coordinated and respectful?
These perspectives need to be interpreted together. A service can have strong protocols but unreliable implementation. It can complete assessments at a high rate without acting on the findings. An outcome can also worsen because the population being served is more complex, rather than because care itself is poorer.
Measurement therefore requires context and judgment, not simply counting.
What might a practical measurement architecture include?
The domains below are not a proposed national indicator set, accreditation framework or HLVN standard. They are a practical way of organizing measurement questions that could be tested, adapted and refined in Vietnamese care settings.
Safety and clinical reliability should remain central. Depending on the setting, this could include medication-related harm, falls with injury, pressure injuries, infection, delirium-related risk, serious incidents or safeguarding concerns. But interpretation matters. A residential facility reporting fewer falls is not necessarily providing better care if residents have been unnecessarily restricted from walking, while a low number of reported medication incidents may reflect poor reporting rather than safer care.
The aim is to understand whether systems are preventing avoidable harm without unnecessarily reducing function, autonomy or appropriate activity.
Function and what matters to the person deserve particular attention in older-person care. WHO’s ICOPE approach focuses on intrinsic capacity, including cognition, mobility, vitality, vision, hearing and psychological capacity. Viet Nam has now moved this concept into national professional guidance: Ministry of Health Decision No. 1976/QĐ-BYT, issued on 1 July 2026, includes initial assessment and screening of intrinsic capacity in home and community care and provides an appendix for using the ICOPE application. It links the findings with further assessment and individualized care planning.
Not every setting needs to measure every domain routinely. A hospital may need to know whether mobility or functional ability declined during admission. Home care may be more interested in whether a person can maintain important daily activities. In long-term care, maintaining function can itself be a valuable outcome even when major improvement is unlikely.
Person-centeredness belongs within the same conversation. A 2026 scoping review specifically examining older adults receiving long-term services and supports identified 11 measurement tools for person-centered care and found substantial variation among them. This evidence should not automatically be generalized to all health-care settings, but it illustrates how difficult person-centeredness is to reduce to a single satisfaction question.
Useful questions may sometimes be quite simple: Were the person’s priorities understood? Were they involved in decisions to the extent they wanted and were able? Did the care plan reflect those priorities? Did they feel listened to and respected?
Continuity and experience reveal what happens between services
Many failures in older-person care occur at the interfaces between organizations rather than entirely within one organization. International quality indicators for older adults’ care transitions already cover domains such as hospitalization, experience, access and waiting times, communication, follow-up and medication-related care.
For Viet Nam, useful transition measures might examine whether discharge information reached the next provider, whether significant medication changes were communicated clearly, whether necessary follow-up occurred, whether rehabilitation or other support needs were addressed and whether the older person knew whom to contact if their condition changed.
The meaningful outcome is not simply that someone was discharged. It is whether the next stage of care actually worked.
Older people and caregivers also see quality problems that routine clinical data may miss. They know whether instructions were understandable, whether different professionals gave conflicting advice, whether a referral was practically inaccessible, whether a family member was expected to perform tasks they were not prepared for, or whether the person felt respected.
Patient and caregiver experience should therefore be treated as information about how the system works, not simply as a public-relations score.
Access, equity and implementation reliability belong in the picture too
Good care has limited value if people cannot reach it. Waiting time, referral completion and access to services such as rehabilitation, geriatric expertise or community support may therefore be relevant measures in some settings.
Averages can also conceal meaningful differences. A program may appear effective overall while working poorly for older people living alone, people with disabilities, people in rural areas or families with fewer financial resources. Where feasible, results should therefore be examined across relevant groups rather than only as one overall percentage.
Implementation reliability is another frequently overlooked part of quality measurement. A program can have an excellent protocol, but was it actually delivered? Did eligible people receive the intended assessment? Did identified needs trigger the intended response? Were referrals completed? When planned care did not happen, why?
Without this information, an organization can conclude that an intervention was ineffective when the real problem was that it was never delivered reliably.
Outcomes matter, but they need context
Readmissions, emergency visits, falls, hospital transfers and mortality are attractive indicators because they appear objective. They are useful, but they can also mislead.
Some readmissions are necessary and appropriate. A long-term-care facility supporting people with advanced frailty may naturally have more hospital transfers than one serving relatively independent residents. A program could reduce falls by restricting mobility in a way that damages independence.
International reviews of both home care and long-term-care facilities explicitly examine risk adjustment and population characteristics, reflecting the difficulty of comparing providers that care for different populations.
This leads to an important distinction:
Measurement for improvement and measurement for external comparison are not the same task.
A hospital can track its own readmission rate over time to understand whether a transition pathway is improving without claiming that its rate is better or worse than another hospital caring for a substantially different patient population.
Every target can change behavior
Quality measures do not simply observe behavior. They can influence it.
If the target is “zero falls,” staff may become overly reluctant to encourage mobility. If the target is “100% of older people assessed,” teams may complete forms even when they lack capacity to respond to what they identify. If readmission becomes the only outcome that matters, an appropriate hospital transfer may begin to look like failure.
This is why balancing measures matter. A falls program might consider both injurious falls and mobility. A hospital-to-home pathway could examine readmissions alongside timely follow-up, function and patient experience. A community assessment program might measure not only assessments completed but also whether identified needs received an appropriate response.
The point is not to avoid targets. It is to understand the behavior a target may encourage.
Measurement should return useful information to care teams
One of the fastest ways to make health professionals disengage from quality improvement is to ask them to collect data that never return to the point of care.
WHO’s indicator-development guidance emphasizes routine monitoring that helps identify quality bottlenecks and supports action rather than data collection for its own sake. A useful test for every proposed indicator is therefore: What decision will we make differently because we know this result?
If no one can answer that question, the measure may not deserve to become routine reporting.
Measurement burden is particularly important in primary and community care, where workforce capacity may already be constrained. Wherever possible, measurement should use information already produced through clinical care and existing information systems before creating parallel reporting structures.
New data should be collected because they fill an important quality gap, not because another international framework contains a longer list of possible indicators.
Viet Nam now has a stronger foundation for measuring older-person care
The policy environment changed substantially during 2025–2026.
The National Strategy for Older Persons to 2035, with a vision to 2045, approved in February 2025, includes objectives related to primary health care, health monitoring, geriatric capacity, rehabilitation and development of care models for older people.
Decision No. 1116/QĐ-TTg, issued on 22 June 2026, amended the Program for Health Care of Older Persons to 2030. It states that from 2026 older people are to receive a free periodic health examination or screening at least once each year and have a health-management record. By 2030, the program targets at least 90% of older people being detected, treated and managed for specified noncommunicable diseases and also expands community care, day-care models, geriatric capacity and workforce development.
Decision No. 1976/QĐ-BYT adds an important implementation layer. The Ministry of Health’s professional guidance for home and community care assigns initial intrinsic-capacity screening to trained commune health-station professionals and other trained community personnel, provides guidance for the use of the WHO ICOPE application and requires results to be connected back to the commune health station for assessment of identified declines and care needs.
The broader national environment is changing as well. Decision No. 1709/QĐ-BYT, issued on 12 June 2026, approved phase I of the National Target Program on Health Care, Population and Development for 2026–2035. Its objectives explicitly include stronger primary health care, adaptation to population aging and greater care for vulnerable groups.
These developments will generate more assessments, services and data. They also make it increasingly important to distinguish coverage from quality.
Knowing how many older people received an annual health assessment tells us about reach. It does not tell us whether identified problems were acted upon, whether referrals worked, whether care became more coordinated or whether meaningful aspects of function and safety improved.
Both questions matter, but they answer different things.
A core-and-modular approach could be practical
One possible architecture for future testing in Viet Nam would have two layers.
The first would be a small core set reflecting fundamental dimensions that matter across much of the older-person care continuum. Depending on the purpose, these might relate to safety, function, person-centeredness, continuity, experience, equity and whether identified needs received an appropriate response.
The second layer would consist of setting-specific modules. Hospitals might place greater emphasis on mobility and cognition during admission, medication safety and discharge transitions. Primary and community care might focus more on intrinsic-capacity assessment, response to identified needs, personalized care planning, referral completion and caregiver support. Home-care services could emphasize deterioration recognition, medication support, continuity, caregiver capability and safeguarding, while residential long-term care could add areas such as falls with injury, pressure injuries, nutrition, infection, functional change, autonomy and resident experience.
These examples are not proposed national indicators. They illustrate how a common measurement logic could remain coherent across the continuum while allowing different settings to measure the risks and responsibilities most relevant to them.
Start small enough to learn
For an organization beginning this work, a pilot could start with a small, manageable set, for example, around eight to twelve measures — provided that every measure has a clear purpose. This is an illustrative starting point, not an evidence-based threshold or a recommended national standard.
The measures themselves should follow the pathway being improved. A hospital-to-home pilot, for example, might combine functional change, medication reconciliation, caregiver readiness, transfer of discharge information, follow-up completion, post-discharge problems, service use and patient or caregiver experience.
A community ICOPE implementation project would need a different set, perhaps including basic assessment, identified needs receiving appropriate further assessment, personalized care-plan completion, referral completion, follow-up, implementation feasibility and selected functional or experience outcomes.
The principle is to keep the initial set small enough that teams can collect the data, understand what they mean and act on the findings. Measures can be added later when experience demonstrates a clear need.
Measurement also needs governance
Choosing indicators is only the beginning.
Organizations need to define who owns each measure, what its numerator and denominator mean, how missing data are handled, how frequently results are reviewed, what findings trigger investigation or action and how learning is returned to frontline teams.
“90% medication reconciliation” means little if different departments use different definitions of completed reconciliation. A dashboard can also look excellent when fields are completed retrospectively mainly to satisfy reporting requirements while the actual care process remains unchanged.
Purpose needs to be explicit as well. Data collected for local improvement should not automatically become the basis for public ranking, payment, certification or regulatory sanctions without appropriate validation, governance and, where needed, risk adjustment.
Trust in measurement depends partly on whether people understand why information is being collected and how it will be used.
Older people should help define what matters
A framework for older-person care should not be designed entirely by professionals.
WHO’s current Technical Working Group developing global standards for quality health care services for older people includes older people and caregivers alongside experts in quality, healthy aging, integrated care, health systems, measurement and evaluation.
The same principle is relevant to Viet Nam. An outcome may look important to professionals while missing something an older person values greatly: remaining able to move around independently, understanding a medication plan, participating in family life, knowing whom to contact after hospital discharge or simply being treated with dignity.
Co-design does not mean every individual preference should become a routine indicator. It means older people and caregivers should have a meaningful role in deciding which aspects of care deserve measurement and whether proposed measures reflect their actual experience of care.
This should not become another standard
A practical measurement framework is not the same thing as an accreditation standard, regulatory requirement or certification scheme.
WHO itself is currently developing standards, indicators and implementation guidance specifically for quality health care services for older people, and that process remains underway. It would therefore be premature for Healthy Longevity Vietnam, or any individual organization, to assemble an indicator list and present it as a definitive national standard.
A more useful role is to test measurement approaches in real settings, determine which measures are feasible and meaningful, understand where data quality is weak, learn how teams actually use the information and refine the approach through implementation.
That learning could eventually contribute to broader quality work in Viet Nam. It should not begin by creating another certification system.
Measure less, learn more
Measurement matters because without it, organizations can easily mistake activity for improvement.
More assessments do not necessarily mean better care. More referrals do not mean people reached the service. More documentation does not mean older people felt heard. Fewer falls do not automatically mean people remained safer and more independent.
The purpose of measurement is to make those differences visible.
For older-person care in Viet Nam, a useful measurement approach should therefore be small enough to use, broad enough to reflect what matters, sensitive to different care settings and closely connected to improvement.
Viet Nam does not need to wait for a perfect national indicator system before learning begins. Hospitals, primary-care services, community programs and long-term-care providers can test carefully defined local measures, examine whether they are feasible and meaningful, use the results to improve care and refine measurement as experience grows.
The most useful question is not “How many indicators should we collect?” It is “What information do we need to know whether care is becoming safer, more person-centered, better coordinated and more responsive to what matters to older people?”
That is the measurement question worth building a system around.
References
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